Scoliosis after cardiac surgery for congenital heart disease: a long-term follow-up study.

BACKGROUND: As survival among patients with congenital heart disease (CHD) has improved, scoliosis after cardiac surgery has increasingly been recognized. However, the clinical characteristics and risk factors associated with scoliosis severity remain incompletely understood. METHODS: We retrospectively reviewed patients who underwent cardiac surgery for CHD at our center between 2000 and 2022 and conducted long-term follow-up. Patients who developed scoliosis were matched with controls without scoliosis using propensity score matching (PSM). Clinical and radiographic data were analyzed. Logistic regression was used to identify independent risk factors for greater scoliosis severity, and Kaplan-Meier analysis to evaluate cumulative incidence. Associations between cardiac morphology and scoliosis severity were also assessed. RESULTS: A total of 39 patients who developed scoliosis after CHD surgery and 39 matched patients without scoliosis were included. The median follow-up duration for the overall cohort was 12.75 (10.55-18.15) years. Compared with the non-scoliosis group, patients with scoliosis had a significantly higher cardiothoracic ratio (CTR) [55.48 [51.68-58.81] vs. 52.04 [46.62-55.56], P = 0.004]. Among patients with scoliosis, females accounted for 58.97%, and the median age at scoliosis diagnosis was 10.56 (8.54-13.16) years. Single thoracic curves predominated, with the apical vertebra most commonly located at the T8-T9 level. Cardiac surgery before 1 year of age was more common among patients with higher Cobb angles and was associated with earlier scoliosis onset. Patients with higher Cobb angles had a higher CTR than those with lower Cobb angles [58.48 [55.39-61.68] vs. 52.85 [49.25-55.88], P = 0.003], and CTR was positively correlated with Cobb angle (r = 0.494, P = 0.001). Multivariate logistic regression showed that a higher CTR was independently associated with greater scoliosis severity (OR 4.79, 95% CI 1.01-22.68, P = 0.048). Relative leftward extension of the cardiac silhouette was positively correlated with Cobb angle (r = 0.470, P = 0.003). CONCLUSIONS: Scoliosis after cardiac surgery for CHD most commonly presented as a right-convex single thoracic curve. A higher CTR was associated with both the presence of scoliosis and greater scoliosis severity. Long-term spinal surveillance should be considered, particularly in high-risk children.